Simulation has been shown to improve trainee performance at the bedside and in the operating room... more Simulation has been shown to improve trainee performance at the bedside and in the operating room. As the use of simulation-based training is expanded to address a host of health care challenges, its added value needs to be clearly demonstrated. Demonstrable improvements will support the expansion of infrastructure, staff, and programs within existing simulation facilities as well as the establishment of new facilities to meet growing needs and demands. Thus, organizational and institutional leaders, faculty members, and other stakeholders can be assured of the best use of existing resources and can be persuaded to make greater investments in simulation-based training for the future. A multidisciplinary panel was convened during the 8th Annual Meeting of the Consortium of the American College of Surgeons-Accredited Education Institutes (Simulation Centers) in March 2015 to discuss the added value of simulation-based training. Panelists shared the ways in which the value of simulatio...
Surgery residents are required to achieve performance milestones to advance in their residency. L... more Surgery residents are required to achieve performance milestones to advance in their residency. Level-specific, technical performance norms that could be used as milestones, however, do not currently exist. Our aim was to develop level-specific, technical performance norms for general surgery residents on select simulated tasks across multiple institutions. An IRB-approved, prospective, multi-institutional collaborative study with voluntary participation of residents was undertaken at the start of the 2011-2012 academic year. General surgery residents (PGY I-V) from seven institutions were tested on three laparoscopic and five open simulated surgical tasks, and their performance was assessed based on task time and errors. Means and standard deviations of performance for each resident level were calculated and compared. Residents with performance 1 standard deviation below the mean were considered outliers. A total of 147 residents were evaluated. Mean resident age was 28 ± 3 years; 42 % were female; and they had attended 74 different medical schools. Senior residents (PGY III-V) had more clinical and simulator experience than junior residents (PGY I-II) (p < 0.001). Resident performance scores progressively increased in all tasks reaching a plateau at a lower PGY level for open tasks. Depending on the task, 0-18 % of residents were outliers. When surveyed, 66 % of residents agreed that national performance norms for residents should exist. Performance norms were established for select tasks in a representative sample of US surgery residents. Such performance norms allow a more informed assessment of resident skill through comparison to national data and enable the identification of outliers who may benefit from additional training.
1. Surg Obes Relat Dis. 2009 May-Jun;5(3):371-4. Epub 2009 Mar 28. Radiographic appearance of end... more 1. Surg Obes Relat Dis. 2009 May-Jun;5(3):371-4. Epub 2009 Mar 28. Radiographic appearance of endoscopic duodenal-jejunal bypass liner for treatment of obesity and type 2 diabetes. Levine A, Ramos A, Escalona A, Rodriguez ...
Because perioperative complications of unrecognized obstructive sleep apnea (OSA) can be severe, ... more Because perioperative complications of unrecognized obstructive sleep apnea (OSA) can be severe, many bariatric surgery programs routinely screen all patients. However, many obese non-bariatric surgery patients do not get screened. We wanted to evaluate the need for routine preoperative OSA screening. Morbidly obese patients with a body mass index (BMI) > 40 kg/m(2) undergoing bariatric surgery--all screened for OSA--were compared to morbidly obese orthopedic lower extremity total joint replacements (TJR) patients--not screened for OSA. Cardio-pulmonary complications were recorded. Eight hundred eighty-two morbidly obese patients undergoing either bariatric (n = 467) or orthopedic TJR surgery (n = 415) were compared. As a result of screening, 119 bariatric surgery patients (25.5 %) were newly diagnosed with OSA, bringing the incidence to 42.8 % (200/467). Orthopedic surgery group had 72 of 415 (17.3 %) patients with pre-existing OSA. The unscreened orthopedic patients had a 6.7 % (23/343) cardiopulmonary complications rate compared to 2.6 % (7/267) for screened bariatric surgery patients. This difference was not statistically significant when adjusted for age and comorbidity (p = 0.3383). Sleep apnea screening prior to bariatric surgery identifies an additional 25 % of patients as having OSA. In this study, unscreened morbidly obese patients did not have an increased incidence of cardiopulmonary complications after surgery compared to screened patients. Prospective randomized studies should be conducted to definitively assess utility and cost effectiveness of routine OSA screening of all morbidly obese patients undergoing surgery. Preoperative OSA screening may be safely omitted when randomizing patients for such a trial.
Several recent articles suggest that utilization of the laparoscopic anterior lumbar interbody fu... more Several recent articles suggest that utilization of the laparoscopic anterior lumbar interbody fusion (ALIF) is decreasing in this country. After reviewing the published evidence in support and in opposition to this approach, we felt that the topic warranted additional study. We began a prospective study utilizing the known techniques to help reduce serious complications. These techniques were previously reported but not widely utilized according to the available literature. We report our early results of eleven patients along with a detailed description of the approach itself with the emphasis aimed at the laparoscopic approach surgeon. One patient was converted to open, with adequate exposure achieved in all. No bleeding complications were seen. Early postoperative results are encouraging. Our conclusions are that the laparoscopic anterior approach to the lumbar spine can be safely performed by approach-surgeons skilled in advanced laparoscopic techniques and those who have also received additional training in laparoscopic anterior lumbar exposures. We feel that improvement over the open approach may be achievable with increased experience.
Simulation has been shown to improve trainee performance at the bedside and in the operating room... more Simulation has been shown to improve trainee performance at the bedside and in the operating room. As the use of simulation-based training is expanded to address a host of health care challenges, its added value needs to be clearly demonstrated. Demonstrable improvements will support the expansion of infrastructure, staff, and programs within existing simulation facilities as well as the establishment of new facilities to meet growing needs and demands. Thus, organizational and institutional leaders, faculty members, and other stakeholders can be assured of the best use of existing resources and can be persuaded to make greater investments in simulation-based training for the future. A multidisciplinary panel was convened during the 8th Annual Meeting of the Consortium of the American College of Surgeons-Accredited Education Institutes (Simulation Centers) in March 2015 to discuss the added value of simulation-based training. Panelists shared the ways in which the value of simulatio...
Surgery residents are required to achieve performance milestones to advance in their residency. L... more Surgery residents are required to achieve performance milestones to advance in their residency. Level-specific, technical performance norms that could be used as milestones, however, do not currently exist. Our aim was to develop level-specific, technical performance norms for general surgery residents on select simulated tasks across multiple institutions. An IRB-approved, prospective, multi-institutional collaborative study with voluntary participation of residents was undertaken at the start of the 2011-2012 academic year. General surgery residents (PGY I-V) from seven institutions were tested on three laparoscopic and five open simulated surgical tasks, and their performance was assessed based on task time and errors. Means and standard deviations of performance for each resident level were calculated and compared. Residents with performance 1 standard deviation below the mean were considered outliers. A total of 147 residents were evaluated. Mean resident age was 28 ± 3 years; 42 % were female; and they had attended 74 different medical schools. Senior residents (PGY III-V) had more clinical and simulator experience than junior residents (PGY I-II) (p < 0.001). Resident performance scores progressively increased in all tasks reaching a plateau at a lower PGY level for open tasks. Depending on the task, 0-18 % of residents were outliers. When surveyed, 66 % of residents agreed that national performance norms for residents should exist. Performance norms were established for select tasks in a representative sample of US surgery residents. Such performance norms allow a more informed assessment of resident skill through comparison to national data and enable the identification of outliers who may benefit from additional training.
1. Surg Obes Relat Dis. 2009 May-Jun;5(3):371-4. Epub 2009 Mar 28. Radiographic appearance of end... more 1. Surg Obes Relat Dis. 2009 May-Jun;5(3):371-4. Epub 2009 Mar 28. Radiographic appearance of endoscopic duodenal-jejunal bypass liner for treatment of obesity and type 2 diabetes. Levine A, Ramos A, Escalona A, Rodriguez ...
Because perioperative complications of unrecognized obstructive sleep apnea (OSA) can be severe, ... more Because perioperative complications of unrecognized obstructive sleep apnea (OSA) can be severe, many bariatric surgery programs routinely screen all patients. However, many obese non-bariatric surgery patients do not get screened. We wanted to evaluate the need for routine preoperative OSA screening. Morbidly obese patients with a body mass index (BMI) > 40 kg/m(2) undergoing bariatric surgery--all screened for OSA--were compared to morbidly obese orthopedic lower extremity total joint replacements (TJR) patients--not screened for OSA. Cardio-pulmonary complications were recorded. Eight hundred eighty-two morbidly obese patients undergoing either bariatric (n = 467) or orthopedic TJR surgery (n = 415) were compared. As a result of screening, 119 bariatric surgery patients (25.5 %) were newly diagnosed with OSA, bringing the incidence to 42.8 % (200/467). Orthopedic surgery group had 72 of 415 (17.3 %) patients with pre-existing OSA. The unscreened orthopedic patients had a 6.7 % (23/343) cardiopulmonary complications rate compared to 2.6 % (7/267) for screened bariatric surgery patients. This difference was not statistically significant when adjusted for age and comorbidity (p = 0.3383). Sleep apnea screening prior to bariatric surgery identifies an additional 25 % of patients as having OSA. In this study, unscreened morbidly obese patients did not have an increased incidence of cardiopulmonary complications after surgery compared to screened patients. Prospective randomized studies should be conducted to definitively assess utility and cost effectiveness of routine OSA screening of all morbidly obese patients undergoing surgery. Preoperative OSA screening may be safely omitted when randomizing patients for such a trial.
Several recent articles suggest that utilization of the laparoscopic anterior lumbar interbody fu... more Several recent articles suggest that utilization of the laparoscopic anterior lumbar interbody fusion (ALIF) is decreasing in this country. After reviewing the published evidence in support and in opposition to this approach, we felt that the topic warranted additional study. We began a prospective study utilizing the known techniques to help reduce serious complications. These techniques were previously reported but not widely utilized according to the available literature. We report our early results of eleven patients along with a detailed description of the approach itself with the emphasis aimed at the laparoscopic approach surgeon. One patient was converted to open, with adequate exposure achieved in all. No bleeding complications were seen. Early postoperative results are encouraging. Our conclusions are that the laparoscopic anterior approach to the lumbar spine can be safely performed by approach-surgeons skilled in advanced laparoscopic techniques and those who have also received additional training in laparoscopic anterior lumbar exposures. We feel that improvement over the open approach may be achievable with increased experience.
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